Literature Review (Grey)
Submitted by: Dementia Panel
Author: Mok Vincent CT
Patients with dementia are particularly vulnerable to SARS-CoV-2 because they may have deficits in understanding, applying or remembering safeguarding procedures such as physical distancing and use of face masks.
Elderly people have higher Covid-19 related mortality rates (up to 12-fold), and a dementia diagnosis carries an additional independent risk of death (hazard ratio = 1.79). ApoE4 genotype could exacerbate neuroinflammation through microglia activation and has an odds ratio of developing severe Covid-19 of 2.31. Impaired consciousness is more common among severely ill Covid-19 patients (14.8% vs 2.4%) and is associated with higher mortality rates (22% vs 1%). A third of Covid-19 patients show a dysexecutive syndrome at discharge, but further data are needed to evaluate long-term impact on cognition. Moreover, patients already diagnosed with dementia have been heavily impacted by the disruption of their social and healthcare network. Many medical appointments are cancelled, family visits and physical activities within care homes have been curbed, and therefore many patients suffer from an exacerbation of behavioural symptoms. Healthcare practitioners could help by addressing the following issues: implement infection control measures, care for basic needs and tackle behavioural problems at home, maintain brain-healthy life-style activities, manage medical and cognitive problems, and support caregivers.